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Kidney disease (nephropathy)

Kidney disease (or diabetic nephropathy) can happen to anyone, but it's much more common in people with diabetes and people with high blood pressure.

Kidney disease in diabetes develops very slowly, over many years. It's most common in people who have had the condition for over 20 years. About 1 in 3 people with diabetes might go on to develop kidney disease, although as treatments improve, fewer people are affected. And there are things you can do yourself to help take care of your kidneys.

What is kidney disease?

The kidneys regulate the amount of fluid and various salts in the body, helping to control blood pressure. They also release several hormones. Kidney disease is when the kidneys start to fail.

If the kidneys start to fail they cannot carry out their jobs so well. In the very early stages there are usually no symptoms and you may not feel unwell, this can mean there are changes in blood pressure and in the fluid balance of the body. This can lead to swelling, especially in the feet and ankles.

As kidney disease progresses, the kidneys become less and less efficient and the person can become very ill. This happens as a result of the build up of waste products in the blood, which the body cannot get rid of. Kidney disease can be a very serious condition.

Why are people with diabetes more at risk?

Kidney disease is caused by damage to small blood vessels. This damage can cause the vessels to become leaky or, in some cases, to stop working, making the kidneys work less efficiently. Keeping blood glucose levels as near normal as possible can greatly reduce the risk of kidney disease developing as well as other diabetes complications. It is also very important to keep blood pressure controlled.

People with diabetes are five times more likely to need either kidney dialysis or a kidney transplant

How does my doctor check for kidney disease?

As part of your annual health care review you should have a blood and urine test. Your urine will be checked for tiny particles of protein, called 'microalbumin'. These appear during the first stages of kidney disease, as the kidneys become 'leaky' and lose protein. At this stage, kidney disease can often be treated successfully, so this test is very important. The blood test will measure urea, creatine, and estimated glomerular function (eGFR) showing how well the kidneys are working.

I had protein in my urine but now the test is negative. How can this happen?

Kidney disease is not the only reason for protein to appear in the urine. If you have a urinary tract infection (UTI) this can lead to protein being passed out in the urine. People with poorly controlled diabetes can be more prone to urinary tract infections because glucose in the urine provides a breeding ground for bacteria. This might need treatment with antibiotics.

In some cases, if the infection persists, it can cause damage to the kidneys, so it is very important for people with diabetes to visit their doctor if they develop a urinary tract infection.

What sort of treatment might be recommended?

This depends on the individual, the type of diabetes and other factors, such as blood pressure. Keeping blood pressure under control is extremely important, and tablets for lowering blood pressure are often used.

An increasingly common form of treatment for people with diabetes is ACE inhibitor or angiotensin II receptor antagonists (AIIRAs). These are particularly successful as they not only lower blood pressure but also help protect the kidneys from further damage. These medications are sometimes used in people who have normal blood pressure, due to their protective effect on the kidneys. Your doctor should discuss any treatment with you before starting you on it, explaining what it does and how it will help.

What if kidney disease gets worse?

There are many ways of treating kidney disease if the kidneys are no longer able to function properly. You may need to limit certain foods in your diet, such as protein foods or foods high in potassium, phosphate or sodium. This aims to prevent waste products building up in your body. As there may be a number of different things to consider, the diet can be quite complicated to follow. If you need to make any changes to your diet, you should receive detailed advice from a registered dietitian.

Controlling blood pressure is also very important. If the kidneys have been damaged, the filtering and cleaning of the blood cannot be done normally.

In some cases, dialysis might be needed to do this job for the kidneys. There are various types of dialysis, and your doctor will discuss with you which one would be best for you.

What can I do to look after my kidneys?

Taking care of your kidneys is an essential part of managing your diabetes.